Patient Engagement Using Telemedicine in Primary Care during COVID-19 Pandemic: A Trial Study.

The correct treatment of most non-transmissible diseases requires, in addition to adequate medication, adherence to physical activity and diet guidelines, as well as health data monitoring and patient motivation. The restrictions caused by the COVID-19 pandemic made telemedicine tools and mobile apps the best choice for monitoring patient compliance. The objective of this study was to analyze the benefits of an m-Health solution designed specifically for chronic patients during the COVID-19 pandemic. A pragmatic clinical trial with pre-post measurements of a single group was carried out with 70 patients (aged 40+) with one or more chronic conditions. Patients were provided with an ad hoc mobile app and health data measuring devices according to their diseases. The health status of the patients was monitored remotely by health professionals who could also modify the patient's objectives according to their evolution. The results obtained show an average fulfillment of objectives of 77%. Higher fulfillment values: medication adherence (98%) and oxygen saturation (82%); lower fulfillment values: weight (48%), glucose (57%), and distance walked (57%). Globally, the ad hoc app was rated 8.72 points out of 10 (standard deviation 1.10). Concerning the pre-post analysis, there were significant improvements vs. prior apps used by the participants in the following items: improved physical activation and better control of blood pressure, diet, weight, glucose, and oxygen saturation. In conclusion, the telemedicine tool developed was useful in increasing patient engagement and adherence to treatment.

Measuring the Impact of Future Outbreaks? A Secondary Analysis of Routinely Available Data in Spain.

Background: As of 7 January 2022, it is estimated that 5.5 million people worldwide have died from COVID-19. Although the full impact of SARS-CoV-2 (COVID-19) on healthcare systems worldwide is still unknown, we must consider the socio-economic impact. For instance, it has resulted in an 11% decrease in the GDP (Gross Domestic Product) in the European Union. We aim to provide valuable information for policymakers by analysing widely available epidemiological and socioeconomic indicators using Spanish data. Methods: Secondary analysis of routinely available data from various official data sources covering the period from 1 March 2020 to 31 March 2021. To measure the impact of COVID-19 in the population, a set of epidemiological and socioeconomic indicators were used. The interrelationships between these socioeconomic and epidemiological indicators were analysed using Pearson's correlation. Their behaviour was grouped according to their greater capacity to measure the impact of the pandemic and was compared to identify those that are more appropriate to monitor future health crises (primary outcome) using multivariate analysis of canonical correlation for estimating the correlation between indicators using different units of analysis. Results: Data from different time points were analysed. The excess of mortality was negatively correlated with the number of new companies created during the pandemic. The increase in COVID-19 cases was associated with the rise of unemployed workers. Neither GDP nor per capita debt was related to any epidemiological indicators considered in the annual analysis. The canonical models of socioeconomic and epidemiological indicators of each of the time periods analysed were statistically significant (0.80-0.91 p < 0.05). Conclusions: In conclusion, during the COVID-19 pandemic in Spain, excess mortality, incidence, lethality, and unemployment constituted the best group of indicators to measure the impact of the pandemic. These indicators, widely available, could provide valuable information to policymakers and higher management in future outbreaks.

Contributing factors for acute stress in healthcare workers caring for COVID-19 patients in Argentina, Chile, Colombia, and Ecuador.

This study analyzed the frequency and intensity of acute stress among health professionals caring for COVID-19 patients in four Latin American Spanish-speaking countries during the outbreak. A cross-sectional study involved a non-probability sample of healthcare professionals in four Latin American countries. Participants from each country were invited using a platform and mobile application designed for this study. Hospital and primary care workers from different services caring for COVID-19 patients were included. The EASE Scale (SARS-CoV-2 Emotional Overload Scale, in Spanish named Escala Auto-aplicada de Sobrecarga Emocional) was a previously validated measure of acute stress. EASE scores were described overall by age, sex, work area, and experience of being ill with COVID-19. Using the Mann-Whitney U test, the EASE scores were compared according to the most critical moments of the pandemic. Univariate and multivariate analysis was performed to investigate associations between these factors and the outcome 'acute stress'. Finally, the Kruskal-Wallis was used to compare EASE scores and the experience of being ill. A total of 1372 professionals responded to all the items in the EASE scale: 375 (27.3%) Argentines, 365 (26.6%) Colombians, 345 (25.1%) Chileans, 209 (15.2%) Ecuadorians, and 78 (5.7%) from other countries. 27% of providers suffered middle-higher acute stress due to the outbreak. Worse results were observed in moments of peak incidence of cases (14.3 ± 5.3 vs. 6.9 ± 1.7, p < 0.05). Higher scores were found in professionals in COVID-19 critical care (13 ± 1.2) than those in non-COVID-19 areas (10.7 ± 1.9) (p = 0.03). Distress was higher among professionals who were COVID-19 patients (11.7 ± 1) or had doubts about their potential infection (12 ± 1.2) compared to those not infected (9.5 ± 0.7) (p = 0.001). Around one-third of the professionals experienced acute stress, increasing in intensity as the incidence of COVID-19 increased and as they became infected or in doubt whether they were infected. EASE scale could be a valuable asset for monitoring acute stress levels among health professionals in Latin America.ClinicalTrials: NCT04486404.

Addressing Acute Stress among Professionals Caring for COVID-19 Patients: Lessons Learned during the First Outbreak in Spain (March-April 2020).

Objectives: To describe lessons learned during the first COVID-19 outbreak in developing urgent interventions to strengthen healthcare workers' capacity to cope with acute stress caused by health care pressure, concern about becoming infected, despair of witnessing patients' suffering, and critical decision-making requirements of the SARS-CoV-2 pandemic during the first outbreak in Spain. Methods: A task force integrated by healthcare professionals and academics was activated following the first observations of acute stress reactions starting to compromise the professionals' capacity for caring COVID-19 patients. Literature review and qualitative approach (consensus techniques) were applied. The target population included health professionals in primary care, hospitals, emergencies, and nursing homes. Interventions designed for addressing acute stress were agreed and disseminated. Findings: There are similarities in stressors to previous outbreaks, and the solutions devised then may work now. A set of issues, interventions to cope with, and their levels of evidence were defined. Issues and interventions were classified as: adequate communication initiative to strengthen work morale (avoiding information blackouts, uniformity of criteria, access to updated information, mentoring new professionals); resilience and recovery from physical and mental fatigue (briefings, protecting the family, regulated recovery time during the day, psychological first aid, humanizing care); reinforce leadership of intermediate commands (informative leadership, transparency, realism, and positive messages, the current state of emergency has not allowed for an empirical analysis of the effectiveness of proposed interventions. Sharing information to gauge expectations, listening to what professionals need, feeling protected from threats, organizational flexibility, encouraging teamwork, and leadership that promotes psychological safety have led to more positive responses. Attention to the needs of individuals must be combined with caring for the teams responsible for patient care. Conclusions: Although the COVID-19 pandemic has a more devastating effect than other recent outbreaks, there are common stressors and lessons learned in all of them that we must draw on to increase our capacity to respond to future healthcare crises.

An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study.

BACKGROUND: The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. OBJECTIVE: In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). METHODS: Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach α and McDonald ω. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. RESULTS: A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald ω). Goodness-of-fit indices confirmed a two-factor structure, explaining 55% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P<.05). CONCLUSIONS: The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic.

Availability of personal protective equipment and diagnostic and treatment facilities for healthcare workers involved in COVID-19 care: A cross-sectional study in Brazil, Colombia, and Ecuador.

Many affected counties have had experienced a shortage of personal protective equipment (PPE) during the coronavirus disease (COVID-19) pandemic. We aimed to investigate the needs of healthcare professionals and the technical difficulties faced by them during the initial outbreak. A cross-sectional web-based survey was conducted among the healthcare workforce in the most populous cities from three Latin American countries in April 2020. In total, 1,082 participants were included. Of these, 534 (49.4%), 263 (24.3%), and 114 (10.5%) were physicians, nurses, and other professionals, respectively. At least 70% of participants reported a lack of PPE. The most common shortages were shortages in gown coverall suits (643, 59.4%), N95 masks (600, 55.5%), and face shields (569, 52.6%). Professionals who performed procedures that generated aerosols reported shortages more frequently (p<0.05). Professionals working in the emergency department and primary care units reported more shortages than those working in intensive care units and hospital-based wards (p<0.001). Up to 556 (51.4%) participants reported the lack of sufficient knowledge about using PPE. Professionals working in public institutions felt less prepared, received less training, and had no protocols compared with their peers in working private institutions (p<0.001). Although the study sample corresponded to different hospital centers in different cities from the participating countries, sampling was non-random. Healthcare professionals in Latin America may face more difficulties than those from other countries, with 7 out of 10 professionals reporting that they did not have the necessary resources to care for patients with COVID-19. Technical and logistical difficulties should be addressed in the event of a future outbreak, as they have a negative impact on healthcare workers. Clinical trial registration: NCT04486404.

Acute stress of the healthcare workforce during the COVID-19 pandemic evolution: a cross-sectional study in Spain.

OBJECTIVES: To determine the volume of health professionals who suffered distress due to their care of patients with COVID-19 and to analyse the direction in which the response capacity of the professionals to face future waves of COVID-19 is evolving. DESIGN: A cross-sectional study. SETTING: Primary care and hospitals in Spain. PARTICIPANTS: A non-randomised sample of 685 professionals (physicians, nurses and other health staff). PRIMARY AND SECONDARY OUTCOME MEASURES: Frequency and intensity of stress responses measured by the Acute Stress of Health Professionals Caring COVID-19 Scale (EASE). Variation of stress responses according to the number of deaths per day per territory and the evolutionary stage of the COVID-19 outbreak measured by the Kruskal-Wallis and the Mann-Whitney U tests. RESULTS: The average score on the EASE Scale was 11.1 (SD 6.7) out of 30. Among the participants, 44.2% presented a good emotional adjustment, 27.4% a tolerable level of distress, 23.9% medium-high emotional load and 4.5% extreme acute stress. The stress responses were more intense in the most affected territories (12.1 vs 9.3, p=0.003) and during the disillusionment phase (12.7 vs 8.5 impact, 10.2 heroic and 9.8 honeymoon, p=0.000). CONCLUSIONS: The pandemic has affected the mental health of a significant proportion of health professionals which may reduce their resilience in the face of future waves of COVID-19. The institutional approaches to support the psychological needs of health professionals are essential to ensure optimal care considering these results.

Preventing and Addressing the Stress Reactions of Health Care Workers Caring for Patients With COVID-19: Development of a Digital Platform (Be + Against COVID).

BACKGROUND: COVID-19 became a major public health concern in March 2020. Due to the high rate of hospitalizations for COVID-19 in a short time, health care workers and other involved staff are subjected to a large workload and high emotional distress. OBJECTIVE: The objective of this study is to develop a digital tool to provide support resources that might prevent and consider acute stress reactions in health care workers and other support staff due to the COVID-19 pandemic. METHODS: The contents of the digital platform were created through an evidence-based review and consensus conference. The website was built using the Google Blogger tool. The Android version of the app was developed in the Java and XML languages using Android Studio version 3.6, and the iOS version was developed in the Swift language using Xcode version 11.5. The app was evaluated externally by the Andalusian Agency for Healthcare Quality. RESULTS: We detected the needs and pressing situations of frontline health care workers, and then, we proposed a serial of recommendations and support resources to address them. These resources were redesigned using the feedback received. A website in three different languages (Spanish, English, and Portuguese) and a mobile app were developed with these contents, and the AppSaludable Quality Seal was granted to the app. A specific self-report scale to measure acute stress and additional tools were included to support the health care workforce. This instrument has been used in several Latin American countries and has been adapted considering cultural differences. The resources section of the website was the most visited with 18,516 out of 68,913 (26.9%) visits, and the "Self-Report Acute Stress Scale" was the most visited resource with 6468 out of 18,516 (34.9%) visits. CONCLUSIONS: The Be + against COVID platform (website and app) was developed and launched to offer a pool of recommendations and support resources, which were specifically designed to protect the psychological well-being and the work morale of health care workers. This is an original initiative different from the usual psychological assistance hotlines.